Discussions To participate in the following discussions, go to this week's Discussion link in the left navigation. Ethical Concerns and Considerations On Day 1 of this course, your instructor will assign you to one of the three options listed below. For your initial post, address the discussion questions associated with option you were assigned. For your responses, select two classmates who were assigned different options than you. Respond to at least two classmates using the required response prompt for their option (e.g., if your initial post was Option 1, then respond to posts from Option 2 and 3 or if your initial post was Option 2, then respond to posts from Option 1 and 3). Your initial post should be at least 250 words; your response post should be at least 100 words. Option 1: Internal Review Board (IRB) Case Studies Review each of the six IRB case studies from Yale University. Select one case and describe it in your discussion post. Indicate in your post which case number you are using. Discuss why you believe the determination was made and whether you believe it was the right or wrong decision. Support your view with at least two scholarly sources from the Ashford University Library. Your initial response should be at least 250 words. Required Response to Option 1: In a substantive post, explain why you agree or disagree with your colleague’s discussion as to whether the determination was right or wrong. Provide additional supportive evidence as to your agreement or disagreement. Your responses should be at least 100 words. Option 2: Ethics Committee Case Study John, a 32 year-old lawyer, had worried for several years about developing Huntington's chorea, a neurological disorder that appears in a person's 30s or 40s, bringing rapid uncontrollable twitching and contractions and progressive, irreversible dementia. It leads to death in about 10 years. John's mother died from this disease. Huntington's is autosomal dominant and afflicts 50% of an affected parent's offspring. John had indicated too many people that he would prefer to die rather than to live and die as his mother had. He was anxious, drank heavily, and had intermittent depression, for which he saw a psychiatrist. Nevertheless, he was still a productive lawyer. John first noticed facial twitching three months ago and two neurologists independently confirmed a diagnosis of Huntington's. He explained his situation to his psychiatrist and requested help committing suicide. When the psychiatrist refused, John reassured him that he did not plan to attempt suicide any time soon. However, when he went home, John pinned a note to his shirt to explain his actions and to refuse any medical assistance that might be offered, then, ingested all of his antidepressant medication. His wife, who did not yet know about his diagnosis, found him unconscious and rushed him to the emergency room without removing the note. What should the care team at the emergency room do? Discuss this question using the following topics and analyzing how these issues are applied to the decision made by the emergency room care team. Use at least two scholarly sources to support your discussion. Your initial post should be a minimum of 250 words. Review of the topics within this case: Medical Indications: There are two diagnoses/prognoses that merit consideration. The underlying chronic disease of Huntington's has no available treatment and a bleak long term prognosis. However, there are effective treatments available for the acute diagnosis of drug overdose. How does the chronic diagnosis affect the team’s response to the acute condition? Patient Preferences: We know from the patient's suicide note that he is refusing all medical treatment. However, what do we know about these statements of preference? Were they informed? Was the patient competent to make that decision? The answers to these questions remain unclear, but we do know that the patient does not have decision making capacity for the present decision of whether to proceed with the gastric emptying. Is there a surrogate decision- maker available? Quality of Life: Life with Huntington's can be difficult with the onset of spasms and dementia. John was familiar with the quality of life associated with living with Huntington's as he watched his mother die of this disease. On the other hand, John does have a supportive family and continues to be able to work for the time being. How should the diminished quality of life that is anticipated in the future affect the current decision? Contextual Features: Several factors in the context of this case are significant. While the patient has a legal right to refuse treatment, he is currently unconscious and his surrogate (his wife) is requesting treatment. There are also certain emergency room obligations to treat emergent conditions. How should the emergency staff weigh the various competing legal and regulatory duties? Required Response to Option 2: Review your classmates’ discussion of the issues that were applied to the decision making process. Explain whether you agree or disagree with all of the ethical considerations they provided, and provide additional notations on the potential positive and negative outcome(s) based on that decision. Your responses should be at least 100 words. Option 3: Mission/Vision/Value Statements Find five hospital or health care organization’s mission, vision and value statements. Discuss the ethical concerns and considerations that were or were not included in these statements. Explain what elements should have been included or excluded. Use at least two scholarly sources from the Ashford Univeristy Library to support your explanation. Your original post must be a minimum of 250 words. Required Response to Option 3: Review the mission, vision and value statements of your classmate’s selected health care organization. Explain whether you agree or disagree with their assessment of the ethical concerns and considerations that were included and/or excluded from the statements. Rewrite one of these statements to better reflect ethical considerations. Your responses should be at least 100 words.